HomeMy WebLinkAboutMortgage_Hollinger STATEMENT OF MORTGAGE OR CONTRACT IiEJTDN ' ouilty Township Year
FOR DEDUCTION FROM ASSESSED VALUATIIODN �g�J
State Form 43709(RD/6-09)
Prescribed by Department of local Government Finance DEC 2 2013 File Mark
INSTRUCTIONS:
Form filed with:
7o be filed in person or by mail with the County Auditor or County Recorder of the coun .here th•pm•ar • • .ted.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is so.•Ty iron j I ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Propert6 t .6 _ dir68 it(b a-,Q2).months
before March 31 of each year the deduction is sought. WI O R 1 ❑ County Recorder
See reverse '•- hstructions and qualifications. •
Applicant(. a - -r-.' rewrm�n�don m- a
Alit A r 4 ` ! Ai At , W1 J-A�.4 __� • `R� r jay
7a21;s trice / Key number l legal
�t o/�7-403— n3. �/0 to t Page ymbp. 7
Assessed vahree of Cereal�yj y as of Mortgage/Contract indebtedness unpaid as of IMMortgage/Caraast indebtedness unpaid as of Is the app&annttt the sole
Mardi 1,current year March 1,current date of application legal or equitable owner?
0 Yes ❑ No
If no,what is his/her exact share of interest? owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyASSrssed
/ I Mobile Horne(IC 6-1.1-7)
Name of mortgagee(x Cconbacl seller A/ n
Address of mortgagee`or contract seller(number and street,c ty.slate,and ZIP code l//"-1/`'�
Name of assignee or other owner or holder of mortgage f
/ -- -••+•n..r_&state.and ZIP code)
t (/�I''/� iunly? . What Taxing District? Has Nis deduction been requested on property .
i Drawer NO...901 for current year? ❑ yes ❑ No
Card 1NO. ...0(2 0 COUNTYAUOROR
l
_. 20 20 120 20•'ol i. ry Iltgr I
County I Date(rtonth,day,year)
I/We certify under the penalty o perjury that the above and foregoing information is true and correct and that the Applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed. I
Signa���L/Jyt�e((owne/s name) _ �Vy'�'[/'//eI` I Date(rtonN,day,year)
resident addresso��� r and stree ty state,and ZIP code)
. 10 l3 S en;aft, Pr;n�D TO-ri 4�/ 1
Person authorized by duty executed Power of or by IC 6-1.1-12-0. I Date(month,day,year)
Address of authorized person (number and street,lily,slate,and ZIP code) .
I
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fwm C3709 (R71 / 609)
�' ,,,, � PreuribeE by Deparbrient of Loral Govemmenl France
INSTRUCTIONS:
To be filed in rson w b mail with the Coun Auditor or Coun Recader of the coun wheie the ��
x r ty a �r woaem rs rocared. �°�� ry
Fdirg Dates: 1) Real Property: Musf file dunrg the year /or which the tleduction is sought. � Coun Auditnr
2) Mobile / ManuFactured Homes rwt assessed as Real Property: Must file dunng the Iwelve (12J months C,
6efore MarcA 31 0! each year the dedixtion is sought. unry Recorder
See reverse side 7a addiGonal instructions erM pualificafions. f:�o�.... __
DistruY
PoP�Y �
I( name on 2cpd'a 6Remrt Nan Ihat af appAren� utl'uate
%( � V[/V •
� cono-aa indnbtean
airtentYeer �- �
Name o1 rtnrtgagee «mntract seAer • �
Addr�s d rtnrtgagee or contrap se�er (num6e� end shee4 �: swe. ertl LP cnOe)
Name o1 assignee w othas ovmer or holder of mortgage .
Dra�r�er NO. c�01.�.. .......
T ' � �� ias Ih6 dedwYi[
or curterv yeaR
Card n0 . .....................
number
1 az o( I Alortgage / ConSarl6Mebtedness unD� as d I Is the eG�t the sale
Eace of appGCatim I�al cr e�ryilade awneR
S ❑ Yes ❑ No
If owne0 wiN someo� other Ihan spouse, IMipte wiN whom
Is iM property in OuesOwr. MnuaOy Ass¢sed
� Real Roperty � Am1ua11yAssessed
Dces ePd�� am Wo7�Y in afry aher
munry in Inaana? ❑ Yes
��,�m����
�
n
v�p�r
❑ No
20 20 _ 20 _ 20 _ 20 _ 2q 20 _
Sigro¢ue d Camb Auditor Counb Date (rt�avh. CaY. Y��
i/ We cerqfy under the penalry of perjury Ihat Ne above and foregoing intortnaGon is We and cortect arW Nat fhe applicant is a resident of IrWiana arW
owner�ntract buyer of the aforementioned pmperry on date applicalion is filed.
Si6re (ownerS �li ^a�^� _� AA Date (mrnCi. daY. Y��)
Pmsan
d appGCant (number anf3trae4 �Y, sfafe. ard LP cotle)
o( author'¢ed persa� (number aM sbea; dry, state. end LP oode)
I